Effective Bilateral ECT for Catatonia in Teen with CACNA1A Variant and ASD

Overview

This case study reports successful treatment of catatonia in a 16-year-old male with a CACNA1A pathogenic variant and autism spectrum disorder using bilateral electroconvulsive therapy (ECT). The patient exhibited unique climbing behaviors as part of catatonia, and significant symptom improvement was documented through clinician, parent, and behavioral analyst assessments.

Background

CACNA1A gene variants are linked to a spectrum of neurological and neurodevelopmental disorders including autism spectrum disorder (ASD) and intellectual disability. Patients with such pathogenic variants may be at increased risk for catatonia, a neuropsychiatric syndrome characterized by motor and behavioral abnormalities. Previous reports have cautioned about ECT use in this population due to potential neurological complications. This case explores the efficacy and safety of bilateral ECT in treating catatonia in a teenager with a CACNA1A variant and ASD.

Data Highlights

Key Findings

• The patient exhibited novel climbing behaviors interpreted as catatonic perseverative stereotypies.
• Initial pharmacological treatments including benzodiazepines and valproic acid yielded minimal improvement.
• Bilateral ECT was initiated after clinical consensus and was well tolerated without neurological complications.
• Significant improvement in catatonia symptoms was observed early in the ECT course, confirmed by clinician, parent, and behavioral analyst reports.
• Use of standardized scales (BFCRS, CIS) enabled objective monitoring of symptom changes.
• This case contrasts with prior reports of unilateral ECT complications in CACNA1A variant patients, suggesting bilateral ECT may be a safer option.

Clinical Implications

Clinicians should consider bilateral ECT as a viable and effective treatment for catatonia in patients with CACNA1A pathogenic variants and ASD, especially when pharmacological interventions fail. Careful monitoring using validated rating scales and multidisciplinary input can guide treatment response and safety. Awareness of atypical catatonic behaviors, such as climbing, is important for accurate diagnosis and management.

Conclusion

This case demonstrates that bilateral ECT can be safely and effectively used to treat catatonia in adolescents with CACNA1A pathogenic variants and ASD, expanding therapeutic options for this challenging comorbidity. Early recognition and intervention are critical to improving outcomes.

References

1. Original Case Study Report -- Effective Bilateral Electroconvulsive Therapy for Catatonia with Unusual Climbing Behavior in a Teenager with a CACNA1A Pathogenic Variant and Autism Spectrum Disorder